On Monday, 20th February, 2017, Aisha was brought in a critical condition to the Umaru Shehu Specialist Hospital, a state government secondary healthcare facility in Maiduguri, the Borno capital.
“She was bleeding from the nose and vagina, vomiting blood and had signs of fever,” said an official involved with the management of the case. She was diagnosed with Lassa fever, an acute viral hemorrhagic disease named after Lassa town in Borno state where the virus was first identified in 1969.
Nigeria is one of seven West African countries where the disease is known to be endemic. According to a World Health Organisation (WHO) report, Lassa fever caused 149 deaths in Nigeria between August 2015 and May 2016, with 89 of those instances confirmed through laboratory testing.
Before she was hospitalised, Aisha, who was pregnant, had first travelled to visit her brother, a trader at an Internally Displaced Persons (IDP) camp in Madinatu where he lived. He took her to a patent medicine store and then suspecting other-worldly factors as responsible for her illness, he took her to a spiritualist. She lost her pregnancy in the process.
Accessing Operational Laboratories
At the Umaru Shehu Specialist Hospital, the female ward was evacuated immediately Aisha was admitted, with the patient isolated due to a high suspicion of Lassa fever infection. Aisha was lucky. Lassa fever is frequently misdiagnosed, leading to a higher mortality rate than necessary. Only two laboratories in Nigeria are equipped to carry out polymerase chain reaction (PCR) test through which the disease can be definitively diagnosed: The Virology laboratory in the Lagos University Teaching Hospital (LUTH) and the Specialist Teaching Hospital in Irrua, Edo State, where the Lassa fever Research and Control Centre is located. Both facilities are in the South of the country, thousands of miles away from Maiduguri. The health minister, Professor Isaac Adewole announced in 2016 that the government through the National Centre for Disease Control (NCDC) would equip six additional centers in Bauchi, Niger, Taraba, Plateau, Nasarawa and Ogun states.
Officials from the Borno state Health Ministry supported by the Federal Government health sector emergency response team escalated Aisha’s case to the officials of the World Health Organisation (WHO).
“We invited the partners, WHO, and swung into action. The specimen was sent to the Lagos University Teaching Hospital on the 21st of February,” said Dr. Mohammed Ghuluze, the State Director of the Emergency Medical Response and Humanitarian Services. “The results returned a week later that confirmed the patient positive.”
While Aisha was undergoing treatment at the Hospital, surveillance teams including environmental health workers were deployed to sanitise the community and get rid of rats, which are known animal hosts of the disease.
“We caught four rats as samples for testing but the Veterinary Teaching Hospital here in Maiduguri lacked the facilities to test the specimen. We sent them to the National Veterinary Research Institute (NVRI) in Vom, Plateau state,” said Mr. Kehinde John, an environmental health expert from the Federal Ministry of Health.
The challenge of Stigmatisation
The team received text messages from members of the community informing them that Aisha will not be accepted back into the community
About 54 persons were recruited to conduct the surveillance exercise involving contact tracing in the areas Aisha visited. The team traced 12 contacts in Zabamari but found nobody with a sign of the fever.
Things turned sour as soon as it became public knowledge that Aisha had come down with Lassa fever. Her brother’s shop at the IDP camp in Madinatu was deserted. Back in Zabamari, the story was similar. “The team received text messages from members of the community informing them that Aisha will not be accepted back into the community,” Samuel Thliza, the state’s chief epidemiologist disclosed.
The health officials however provided frequent updates to the community and religious leaders on Aisha’s progress. Her samples tested negative on the second and third weeks. The community eventually became persuaded following a visit from the health team. “We told them the patient would be discharged on the 14th of March. After the discharge she was led to the community for acceptance. The health team told the traditional rulers she is a no longer a risk person to the community,” Thliza said.
[Editing by Stanley Azuakola. Please credit Machaha (machaha.com), a Gatefield Impact, social change project focused on the Sustainable Development Goals]
